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 Nutrition
Maintaining and improving health

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This page intentionally left blank
 Nutrition
Maintaining and improving health

Fourth edition

Geoffrey P Webb BSc MSc PhD

Nutrition writer, and consultant at the School of Health,
Sport and Bioscience, University of East London, London, UK

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 First published in Great Britain in 1994 by Butterworth Heinemann
Second edition 2002 and third edition 2008 by Hodder Arnold

This fourth edition published in 2012 by

Hodder Arnold, an imprint of Hodder Education, a division of Hachette UK

338 Euston Road, London NW1 3BH

www.hodderarnold.com

© 2012 Geoffrey P Webb

All rights reserved. Apart from any use permitted under UK copyright law,
this publication may only be reproduced, stored or transmitted, in any form,
or by any means with prior permission in writing of the publishers or in the
case of reprographic production in accordance with the terms of licences
issued by the Copyright Licensing Agency. In the United Kingdom such
licences are issued by the Copyright Licensing Agency: Saffron House, 6–10
Kirby Street, London EC1N 8TS

Hachette UK’s policy is to use papers that are natural, renewable and
recyclable products and made from wood grown in sustainable forests. The
logging and manufacturing processes are expected to conform to the
environmental regulations of the country of origin.

Whilst the advice and information in this book are believed to be true and
accurate at the date of going to press, neither the author nor the publisher can
accept any legal responsibility or liability for any errors or omissions that may
be made. In particular (but without limiting the generality of the preceding
disclaimer) every effort has been made to check drug dosages; however it is
still possible that errors have been missed. Furthermore, dosage schedules are
constantly being revised and new side-effects recognized. For these reasons
the reader is strongly urged to consult the drug companies’ printed
instructions before administering any of the drugs recommended in this book.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress

ISBN-13 978-1-4441-4246-4

1 2 3 4 5 6 7 8 9 10

Commissioning Editor: Naomi Wilkinson

Project Editor: Mischa Barrett
Production Controller: Francesca Wardell
Cover Design: Lynda King
Cover image © Corbis

Typeset in Berling Roman 9.5 pts by Datapage (India) Pvt. Ltd.

Printed and bound in Spain by Graphycems

What do you think about this book? Or any other Hodder Arnold title?
Please visit our website: www.hodderarnold.com

Some figures in the printed version of this book are not available for inclusion in the eBook for copyright reasons.

Book Interior Layout.indb 4 7/26/12 8:57 PM

 For my daughter Kate Webb on the understanding
that she dedicates her first book to me.

Accessing the resources on the companion website

Resources supporting this book are available online. These include:

● An outline of a course based on this text with cross references to the book
● PowerPoint slides that give the framework of this course of lectures
● Answer plans for sample short-note and essay-type exam questions
● References with links to free copies of many of the sources cited
● A comprehensive glossary of terms.

To access these materials go to www at www.hodderplus.co.uk/nutrition-webb and click on

‘additional resources’ in the right hand menu.
The first time you visit the website, you will need to register with your serial number.
Serial number prs6285fgt (There is a link for this below the log in box.)
Once you have registered you will not need the serial number but can log in using your email
address and the password you set up during registration.

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 Contents

Preface xi
Acknowledgements xiv

PART 1 – CONCEPTS AND PRINCIPLES

1. Changing priorities for nutrition education 3

Identification of the essential nutrients 3
Adequacy: the traditional priority in nutrition 5
The current priority: diet as a means to health promotion or disease prevention 7
Is intervention to induce dietary change justified? 16
Effecting dietary change 23
Concluding remarks 29

2. Food selection 30
Introduction and aims of the chapter 30
The biological model of food 31
Dietary and cultural prejudice 32
Food classification systems 33
Non-nutritional uses of food 38
The hierarchy of human needs 39
A model of food selection: the ‘hierarchy of availabilities’ model 41
Physical availability 42
Economic availability 43
Cultural availability 56
‘Gatekeeper’ limitations on availability 62

3. Methods of nutritional assessment and surveillance 64

Introduction and aims of the chapter 64
Strategies for nutritional assessment 64
Measurement of food intake 65
Tables of food composition 72
Dietary standards and nutrient requirements 75
Clinical signs for the assessment of nutritional status 85
Anthropometric assessment in adults 86
Anthropometric assessment in children 92
Estimating fatness in animals 94
Biochemical assessment of nutritional status 95
Measurement of energy expenditure and metabolic rate 98

4. Methods to establish links between diet and chronic disease 102

Introduction and aims of the chapter 102
Strategic approaches: observational versus experimental 102
Features and problems of epidemiological methods 104
Cross-cultural comparisons 107

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 Contents  vii

Time trends 110

Migration studies 112
Cohort studies 112
Case–control studies 115
Cross-sectional studies 117
‘Experiments’ of nature 118
Animal experiments 118
Human experimental studies 121
In-vitro studies 132
Scientific honesty 133

5. Dietary guidelines and recommendations 134

The range of ‘expert reports’ and their consistency 134
Variations in the presentation of guidelines and recommendations 136
‘Food’ recommendations 137
Energy and body weight 139
Recommendations for fats, carbohydrates, protein and salt 140
Alcohol 143
How current UK diets compare with ‘ideal’ intakes 146
Other nutrients 147
Willingness to change 147
Some barriers to dietary change 149
Aids to food selection 150
Concluding remarks 154

6. Cellular energetics 156

Introduction and aims of the chapter 156
Overview of metabolism 156
Metabolism of glucose and the monosaccharides 158
Metabolism of fatty acids and glycerol 160
Metabolism of amino acids 161
The pentose phosphate pathway 161
Overview of macronutrient handling in the gut 162

PART 2 – ENERGY, ENERGY BALANCE AND OBESITY

7. Introduction to energy aspects of nutrition 167

Sources of energy 167
Units of energy 167
How energy requirements are estimated 168
Variation in average energy requirements: general trends 170
Energy content of foods 171
Sources of dietary energy by nutrient 172
Energy density 174
Nutrient density 176
Sources of dietary energy by food groups 177
Starvation 178
Eating disorders 182
Cancer cachexia 185

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 viii  Contents

8. Energy balance and its regulation 187

The concept of energy balance 187
Physiological regulation of energy balance 188
The ‘set point’ theory 189
Is energy expenditure regulated? 189
External influences on food intake 192
Control of energy intake 192
The leptin story 198

9. Obesity 202
Defining obesity 202
Prevalence of obesity 203
Consequences of obesity 211
The metabolic syndrome or ‘syndrome X’ 219
Causes of obesity 219
Prevention and treatment of obesity in populations 229
Obesity treatment in individuals 232
‘Aggressive’ treatments for obesity 237

PART 3 – THE NUTRIENTS

10. Carbohydrates 245

Introduction 245
Nature and classification of carbohydrates 246
Dietary sources of carbohydrates 247
Sugars 248
Artificial sweeteners 250
Diet and dental health 252
Starches 255
Non-starch polysaccharide 257
Resistant starch 260
The glycaemic index 261
Dietary factors in the aetiology of bowel cancer 262
Dietary factors in heart disease 266

11. Protein and amino acids 268

Introduction 268
Chemistry and digestion 268
Intakes, dietary standards and food sources 270
Nitrogen balance 271
Protein quality 274
The significance of protein in human nutrition 278
Concluding remarks 284

12. Fats 285

Nature of dietary fat 285
Types of fatty acid 287
Sources of fat in the human diet 291
Roles of fat in the diet 294

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 Contents  ix

Blood lipoproteins 300

Digestion, absorption and transport of dietary lipids 301
Transport of endogenously produced lipids 303
The diet–heart hypothesis 304
Fish oils 317
Other natural oils used as supplements 322

13. The micronutrients 324

Scope of this chapter 324
Overview of dietary supplements 325
Food fortification 329
Assessment of the micronutrient adequacy of British adults 330
Anti-oxidants and the oxidant theory of disease 335
Do high anti-oxidant intakes prevent heart disease, cancer and other chronic diseases? 341
Use of substances other than essential nutrients as dietary supplements 346

14. The vitamins 357

General concepts and principles 357
Vitamin A (retinol) 361
Vitamin D (cholecalciferol) 365
Vitamin E (α-tocopherol) 371
Vitamin K (phylloquinone) 372
Thiamin (vitamin B1) 374
Riboflavin (vitamin B2) 376
Niacin (vitamin B3) 377
Vitamin B6 (pyridoxine) 380
Vitamin B12 (cobalamins) 381
Folate or folic acid (vitamin B9) 383
Biotin 389
Pantothenic acid 389
Vitamin C (ascorbic acid) 390

15. The minerals 393

Introduction 393
Chromium 394
Copper 395
Fluoride 396
Magnesium 396
Manganese 397
Molybdenum 398
Phosphorus 398
Potassium 398
Selenium 399
Zinc 400
Iodine and iodine-deficiency diseases 402
Iron and iron-deficiency anaemia 405
Calcium storage and uptake 410
Calcium and bone health 414
Sodium and disease 421
Review of evidence for a salt–hypertension link 427

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 x  Contents

PART 4 – VARIATION IN NUTRITIONAL REQUIREMENTS AND PRIORITIES

16. Nutrition and the human lifecycle 435

Introduction 435
Nutritional aspects of pregnancy 437
Lactation 448
Infancy 449
Childhood and adolescence 462
The elderly 469

17. Nutrition as treatment 484

Diet as a complete therapy 484
Diet as a specific component of therapy 488
Malnutrition in hospital patients 496

18. Some other groups and situations 507

Vegetarianism 507
Racial minorities 513
Nutrition and physical activity 519

PART 5 – THE SAFETY AND QUALITY OF FOOD

19. The safety and quality of food 533

Aims of the chapter 533
Consumer protection 533
Food poisoning and the microbiological safety of food 540
Bovine spongiform encephalopathy 554
Food processing 560
The chemical safety of food 564
Functional foods 573
Index 584

The Glossary and References are available online at www.hodderplus.co.uk/nutrition-webb

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 Preface

It was 20 years ago, while a visiting professor at the aspects of nutrition and the micronutrients are now
University of North Florida in early 1992, that I much more extensive, and there are short sections
took the first tentative steps towards producing the dealing with a variety of topics not covered in the
first edition of this book. My aim was to produce a first edition, including dietary supplements,
comprehensive text covering all aspects of nutrition functional foods, superfoods, meta-analysis, and the
for students at various academic levels but who had scale and implications of world population growth.
no previous academic experience of studying There are bullet-point summaries of ‘key points’ at
nutrition. I aimed to make the book accessible to the ends of each major section in the book, and
students from different academic backgrounds who feedback from my own students suggests that these
might have limited background knowledge of are a popular ‘student-friendly’ addition to the text.
biochemistry and/or the physical and mathematical Some of the changes in the book have been driven
sciences. My main focus was on the role of diet and by changes in nutrition itself, but many more have
nutrition in promoting health in people living in been driven by changes and development of the
affluent countries – hence the title, Nutrition: A author. These developments have been accelerated
health promotion approach. Despite this title, the by researching and writing scholarly articles and
book contained only a brief discussion of health other books on topics such as weight control,
promotion theory and health promotion as a nutrition of the elderly, and dietary supplements
discipline in its own right. So, in order to make the and functional foods.
general health-promoting aims of the book clear – What has happened in nutrition over the last
but without implying a substantial component of 20 years? There has been a marked tendency to
health promotion theory – a new title has been medicalize eating – a blurring of the boundaries
chosen: Nutrition: Maintaining and improving health. between nutrition and pharmacy. Food and food
I have not ignored the nutritional issues and components are increasingly being consumed in the
problems of the developing world, but the bulk of often vain hope that they will prevent or treat
discussion is aimed at students living and intending diseases or slow the ageing process. A third of
to work in the affluent countries of Europe, North British adults take dietary supplements (nutrition
America and Australasia. I have tried to avoid in pill form); there has been a massive growth in
writing yet another science-based but prescriptive the market for so-called ‘functional foods’ or
guide to healthy eating; rather I have sought to nutraceuticals that are marketed on their potential
identify the current consensus on major issues and health benefits; and more recently the promotion of
topics in nutrition and to critically discuss and some sometimes novel and often expensive foods as
evaluate the evidence that underpins these views – ‘superfoods’ because they are rich in particular
and where appropriate to discuss alternative nutrients, phytochemicals, antioxidants, essential
opinions. I have included a substantial section fatty acids or dietary fibre.
dealing with the methods used to study nutrition, The BSE or ‘mad cow’ crisis was a major nutrition-
not just to help prepare students who might want to related event in the UK. When I started writing the
carry out these procedures, but also to empower all first edition, the epidemic of this new fatal disease
students to be able to read, understand and critically of cattle was reaching its peak, but there was still no
evaluate the scientific literature. evidence that the disease would directly affect
How has the book changed over 20 years? Each people. In 1996, the British government announced
new edition has been larger than its predecessor, the first cases in young people of a new and
and this fourth edition must be close to double the invariably fatal neurological disease (variant CJD)
length of the first. The sections dealing with energy that was almost certainly caused by eating beef from

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 xii  Preface

cattle ‘infected’ with BSE. There were dire expensive reports that I had to buy in hard copy are
predictions in the media and by some academics now available to download without charge, and I
that tens of thousands of young people would suffer can almost always obtain at least a free abstract of
a protracted neurological degeneration and die of any published scientific paper and can often read
this disease over the following 20 years. Both the the whole paper without cost because it has become
cattle and human epidemics now seem to be all but open access. The references cited in this fourth
over. Hundreds of thousands of infected cattle and edition are now supplied as an online resource and
millions of apparently healthy cattle have been so, to facilitate the student reader’s access to this
slaughtered and burnt to try to eradicate the disease. vast array of free published material, I have included
The human epidemic may have been thankfully links to free copies of many of the sources used.
small (175 deaths spread over 18 years), but the Readers in many institutions, especially research-
disease has cost the British taxpayer billions of focused universities, should be able to access even
pounds, had a devastating effect on British farming more of these sources by using their institution’s
for over a decade, and undermined consumer password-protected authentication system.
confidence in modern farming, food production The online material includes the references, a
methods and government food safety regulation. glossary and the following resources:
How have developments in information techno­
logy affected the writing process and the way in • The outline syllabus for a generic ‘Introduction to
which nutrition and other subjects are studied? Nutrition’ module with indications of where to find
When I started to research and write the first the relevant information in the text. This module is
edition, I was just starting to use e-mail and had not based on a nominal two lectures per week for 20
yet used the internet. I had to obtain my source weeks but can be shrunk or expanded to meet
material by physically visiting libraries, searching the specific requirements of any particular course
the literature using huge volumes of paper indexing or group of students.
systems like Index Medicus, and then sending off • A series of Microsoft PowerPoint slides that give the
scores of postal requests for hard copies of books detailed framework for each pair of lectures. These
and research papers using the Inter Library Loan can obviously be modified by individual tutors to
system. I had to buy expensive hard copies of expert meet their specific needs. These slides are
reports such as COMA reports on nutrition-related designed to be used by tutors as triggers for
topics and statistical surveys such as the Health discussion and elaboration and are not intended
Survey for England and the UK National Diet and to be complete sets of lecture notes. I suggest to
Nutrition surveys. Obtaining statistical data from my own students that they print the slides three
other countries and making international to a page, and use the space on the right of each
comparisons was a difficult and frustrating process, slide to make additional notes.
and often the end-results of this hard work were • A series of generic questions with plans of how they
incomplete and unsatisfactory. I now have a vast should be answered. I have included a series of
range of high-quality up-to-date statistical data, short-note questions where students would be
expert reports, academic reviews and research expected to write brief accounts of well-defined
papers available to me free online. I can access this topics; for my own students I am content for these
material without moving from my desk, ‘at the answers to be a series of clear, concise bullet
click of a mouse’. I can search for source material points. I have assumed in providing the answer
using powerful search engines, for material plans that students would have 10–15 minutes of
produced by governments, international agencies, examination time to answer each question. I have
charities, professional bodies and expert groups, also included a smaller number of full essay
and use an academic search engine like Medline or questions where students would be expected to
PubMed to find material published in scientific write a structured and in-depth account of a
journals. I can then often access this information broader topic; for higher level students there
instantly and at no direct cost to me. Most of the might be a requirement for critical discussion and

Book Interior Layout.indb 12 7/26/12 8:57 PM

 Preface  xiii

evaluation within the answer. These plans are This new edition together with the additional online
intended to be used as a tool by students to guide resources is intended to be a complete learning and
the final stages of revision for their examinations. teaching package that individual tutors can shape
Note that several short notes could be combined and flesh out to meet the specific needs of their
to make an essay question, or one essay could courses and students.
yield several short-note questions. Geoffrey Webb
February 2012

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 Acknowledgements

With thanks to Naomi Wilkinson, Mischa Barrett, Joanna Silman and the rest of the Hodder team involved
with this edition.

Book Interior Layout.indb 14 7/26/12 8:57 PM

 PART ONE

CONCEPTS AND
PRINCIPLES

1 Changing priorities for nutrition education 3

2 Food selection 30
3 Methods of nutritional assessment and surveillance 64
4 Methods to establish links between diet and chronic disease 102
5 Dietary guidelines and recommendations 134
6 Cellular energetics 156

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This page intentionally left blank
 1
Changing priorities for
nutrition education

Identification of the essential nutrients 3 Is intervention to induce dietary change

Adequacy: the traditional priority in nutrition 5 justified? 16
The current priority: diet as a means to Effecting dietary change 23
health promotion or disease prevention 7 Concluding remarks 29

Identification of the essential Pellagra remained a problem in several southern

nutrients states of America until the 1940s.
• In the late nineteenth and early twentieth
Scientific research into food and nutrition was centuries, up to 75 per cent of children in some
initially directed towards identifying the essential British industrial cities suffered from rickets,
nutrients and quantifying our requirements for which was shown to be due to lack of vitamin D.
them. All of the essential nutrients must be present Again, it was not until the 1940s that this disease
in our diets in certain minimum quantities if we are was largely eradicated in British children. Rickets
to remain healthy. These essential nutrients can be can be cured either by consuming vitamin D or
broadly divided into two categories. by exposing the skin to summer sunlight which
enables us to make our own vitamin D.
• The macronutrients – carbohydrates, fats and
• Beriberi exacted a heavy toll of death and misery
protein, which are required in relatively large
in the rice-eating countries of the Far East well
quantities and can act as dietary sources of energy.
into the third quarter of the twentieth century. It
• The micronutrients – vitamins and minerals which
is cured by thiamin (vitamin B1), a vitamin that
are only required in small amounts (milligram or
is largely removed from white rice during
microgram quantities) and which do not act as
milling.
sources of energy.
The impact of this work was such that several Nobel
A shortage of one of the essential micronutrients
prizes in Physiology, Medicine or Chemistry were
leads to adverse symptoms, often to a characteristic
awarded for work on the vitamins; between 1929
deficiency disease. In the first half of the twentieth
and 1943 11 people shared seven Nobel prizes for
century, many essential nutrients were identified
vitamin-related work. It was his work on thiamin
and their ability to cure these deficiency diseases
and beriberi, mentioned above, for which Christiaan
was recognized. Some examples are given below.
Eijkman received the 1929 prize.
• Niacin (vitamin B3) was shown to cure the Such spectacular successes as these may have
deficiency disease pellagra. This often fatal disease encouraged a ‘magic bullet’ image of nutrition – the
was so prevalent in some southern states of the expectation that simple dietary changes may be able
USA in the early decades of the twentieth century to prevent or cure diseases other than those due to
that it was thought to be an infectious disease. dietary inadequacy. This expectation is generally

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 4  1 Changing Priorities for Nutrition Education

misplaced, although there is no doubt that poor Around 40 essential nutrients have now been
nutritional status can adversely affect the course of all identified, namely:
illnesses and some conditions do respond to restriction
• water
or extra supply of some dietary components. For
• energy sources
example, the symptoms and/or progression of
• protein and the nine essential amino acids
diabetes mellitus and chronic renal failure can be
• essential fatty acids
controlled to a degree by diet (see Chapter 17). There
• the vitamins A, C, D, E and K
are even a few, relatively uncommon diseases whose
• eight substances that make up the B group of
symptoms are due to an inborn or acquired
vitamins
intolerance to a specific component of food. In these
• around 15 minerals and trace minerals.
cases, while diet does not strictly cure the condition,
the symptoms can be controlled by preventing or In most cases, these nutrients have not only been
limiting intake of the offending substance; for identified but good estimates of average
example: requirements have also been made. Many
governments and international agencies use these
• phenylketonuria (intolerance to the essential
estimates of requirements to publish lists of dietary
amino acid phenylalanine)
standards that can be used as yardsticks to test the
• galactosaemia (intolerance to one of the
adequacy of diets or food supplies. These standards
components of milk sugar – galactose)
are variously termed ‘recommended dietary/daily
• coeliac disease (intolerance/delayed hypersensitivity
allowances’ (RDAs) or ‘dietary reference values’
to the wheat protein, gluten)
(DRVs) and they are discussed fully in Chapter 3.
• acute hypersensitivity (an acute allergic response
to a particular food or ingredient, such as shellfish
or peanuts). Conditionally essential nutrients
There are also a few conditions where the symptoms Some substances may be required in the diet only
are alleviated by increased intake of a nutrient. For under particular circumstances or be required only
example, pernicious anaemia is an autoimmune by particular groups of people, such as in
condition that results in an inability to absorb premature babies, people with genetic defects or
vitamin B12 and is relieved by injections of the people with other pathological conditions. Harper
vitamin. (1999) designated these as conditionally essential
Harper (1999) gave a list of criteria for establishing nutrients and defined them as substances that
that a nutrient is essential. are ‘not ordinarily required in the diet but which
must be supplied exogenously to specific groups
• The substance is essential for growth, health and
that do not synthesise them in adequate amounts’.
survival.
Examples are as follows.
• Characteristic signs of deficiency result from
inadequate intakes and these are cured only by • L-carnitine may be essential in people with rare
the administration of the nutrient or a known inherited disorders of fatty acid metabolism.
precursor. • The amino acid glutamine may become essential
• The severity of the deficiency symptoms is dose in people with serious illness or injury because
dependent; they get worse as the intake of they cannot synthesize it quickly enough to meet
nutrient decreases. their increased needs.
• The substance is not synthesized in the body (or • The amino acids cysteine and tyrosine may be
only synthesized from a specific dietary precursor) conditionally essential for premature babies who
and so is required throughout life. Note that a have not yet developed the enzymes necessary
strict application of this rule would eliminate for their synthesis.
vitamin D which can be synthesized in the skin in • Tyrosine becomes an essential amino acid in
sufficient amounts to meet our needs provided people with the inherited disease phenylketonuria
the skin is regularly exposed to summer sunlight. (mentioned earlier).

Book Interior Layout.indb 4 7/26/12 8:57 PM

 Adequacy: the traditional priority in nutrition  5

Conditionally essential nutrients are discussed Key points continued

further in Chapter 13.
Some substances that have vitamin-like functions ●● These discoveries may have encouraged the
in the body but which are not considered to be illusion that dietary change could cure many
essential are frequently taken as dietary supplements; other diseases.
examples are L-carnitine, creatine, glucosamine, ●● A nutrient is classified as essential if it is
coenzyme Q10 and s-adenosyl methionine. The needed for growth and survival, if deprivation
implication underpinning their use as supplements leads to dose-dependent symptoms of
is that endogenous synthesis may not always ensure deficiency, and if the substance is not
synthesized in sufficient quantities to meet
optimal health or may become insufficient in certain
physiological needs.
pathological states. In effect it is being implied that
they can become conditionally essential nutrients. ●● Some nutrients are classified as conditionally
essential because they are essential only in
Several of these substances are briefly overviewed in
some circumstances or for some people.
Chapter 13 and discussed in greater depth in Webb
(2011a). ●● Some endogenously produced substances with
vitamin-like functions are promoted as dietary
Some other substances may be desirable for health
supplements with the implication that they
while not meeting the criteria for essentiality.
may become conditionally essential under
Examples are fluoride for its beneficial effects on some circumstances.
teeth, and dietary fibre for its effects on gut function.
●● Although dietary change can rarely cure or
Some nutrients may also be used in doses that greatly remove the symptoms of a disease, the
exceed those that would be obtained from food to progress of all diseases will be affected by
produce a pharmacological effect (i.e. they are used poor nutritional status.
as drugs); for example, nicotinic acid (vitamin B3) ●● In a few fairly uncommon conditions, diet may
has been used as a cholesterol-lowering agent. be the sole therapy possibly because the
There are also tens of thousands of substances symptoms are due to intolerance to a food or
termed secondary plant metabolites that are present a component of food.
in the plant foods we eat. While they are not ●● Some nutrients may be used in
essential or even conditionally essential nutrients, pharmacological quantities (i.e. used as drugs).
many of these may have beneficial (or deleterious) ●● Intakes of some ‘nutrients’ may be desirable
effects on health. Plant preparations and extracts for health, while not being strictly essential.
have been used as herbal medicines throughout ●● Plants produce thousands of so-called
human history, and many of them are now marketed secondary metabolites that may have
and promoted as dietary supplements (or traditional beneficial or deleterious effects on health.
herbal products within the EU) useful for Some of these have been developed into
maintaining or restoring health. A number of these effective drugs and some are potent poisons.
secondary plant metabolites are popular and ●● Around 40 essential nutrients have been
effective drugs and several are potent poisons. identified and estimates of average
These secondary metabolites are classified and requirements have been made and published
briefly overviewed in Chapter 13, and are discussed as ‘recommended dietary/daily allowances’
at greater length in Webb (2011a). (RDAs) or ‘dietary reference values’ (DRVs) in
the UK.

Key points
●● In the first half of the twentieth century most Adequacy: the traditional priority
of the vitamins were discovered and the ability in nutrition
of vitamin and mineral supplements to cure
deficiency diseases was recognized. The traditional priority in nutrition has been to
➔ ensure nutritional adequacy; that is, to ensure that
diets contain adequate amounts of energy and all

Book Interior Layout.indb 5 7/26/12 8:57 PM

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